Treatments and Services

Epilepsy Program

What is the Epilepsy Program?

Seattle Children’s has the largest program on the West Coast to treat babies, children and teens who have repeated seizures. The key to treating your child successfully is to accurately diagnose the type of seizures they have and the type of epilepsy or epilepsy syndrome. Our team has many years of experience in diagnosing and treating epilepsy.

What’s special about the Epilepsy Program at Seattle Children’s?

Our Epilepsy Program is the only pediatric program in the Northwest that is accredited level 4 by the National Association of Epilepsy Centers (NAEC). A level 4 center uses the most advanced technology to diagnose epilepsy and evaluate patients before surgery. Only level 4 centers perform a broad range of complex surgeries to treat epilepsy.

Epilepsy Monitoring Unit: We have a specially equipped area of the hospital to carefully monitor your child’s brain activity and see how seizures affect them. Using electroencephalogram (EEG) and video to study your child for several days helps us understand their seizures, make an accurate diagnosis and recommend the best treatment.

State-of-the-art imaging technologies help us see where seizures start in your child’s brain. These include MRI scans, PET scans and functional MRI. We map areas of the brain that control speech, memory and movement so we can operate safely and most effectively.

At Seattle Children’s, our treatment options for children with epilepsy include medicines, special diets, implanted nerve stimulators, brain surgery, physical therapy, occupational therapy and speech therapy. The right choices for your child depend on their seizures.

We are among only a handful of children’s hospitals in the country that offer laser ablation surgery for epilepsy. This minimally invasive procedure offers the chance for some kids who have run out of treatment options to live seizure free.

Our patients have the option to take part in research along with their regular medical treatment. Seattle Children’s doctors lead research in the lab and in the clinic to improve epilepsy treatment and quality of life for children with seizures. See Seattle Children’s Epilepsy Research and Clinical Trials.

In brain mapping, doctors place electrodes on many parts of your child’s brain. These electrodes can help find where seizures start. They also identify critical parts of the brain, such as those needed for talking and moving. This helps make your child’s surgery safer and more effective. Sometimes surgeons must remove parts of the skull to place the electrodes. In other cases, they use robotic tools that fit through tiny holes in the skull (stereo EEG).

During a comprehensive evaluation, we monitor the electrical activity in your child’s brain and do brain imaging studiesand neuropsychological testing. These tests help us find out more about the seizures and how they affect your child. Your child stays in our special epilepsy monitoring unit for up to 1 week. During that time, we use EEG equipment, a painless way to record the brain’s electrical activity.

We make video and sound recordings of your child to see and hear what happens when they have a seizure. We also use brain imaging techniques such as MRI scans, PET scans and SPECT scans. These images, along with neuropsychological testing, help us see patterns of behavior and movement and find the source of seizures.

Our team of experts from different specialties is finding the changes in genes that cause many of the epilepsies seen in children. We do genetic testing to help diagnose disorders. Our genetic counselors help families understand the chances of a genetic disorder happening in another pregnancy. They explain how other family members might be affected. Our experts also consult with other healthcare professionals about children at other centers.

We evaluate children who have had a seizure for the first time to learn more about the type of seizure, its cause and whether they may have epilepsy. It is important to determine if the seizure was provoked (caused by a temporary problem like a concussion or high fever) or is an epileptic seizure. Epilepsy is not the cause of seizures in up to half of children who visit our clinic.

At your first visit, a neurology provider checks your child and talks with you about seizures.

If needed, your child has an EEG, a painless recording of the brain’s electrical activity. The EEG may happen that same day or in 1 or 2 days.

Some children return to the clinic to see a neurologist and epilepsy specialist.

If medicine does not control your child’s seizures, they may benefit from nutrition therapy – either the ketogenic diet or the modified Atkins diet. Diet therapy can lessen or stop seizures for some children. Usually, children still take medicine, but they are able to take less.

The nutrition team will help you decide if 1 of the diets is the right choice for your child. On both diets, children eat foods that are high in fats and low in carbohydrates. The team helps to make sure your child is receiving nutrients they need to grow and keep a healthy weight. Children on these diets should always be under a doctor’s care.

Ketogenic diet

The ketogenic diet includes eating foods that are high in fat and very low in carbohydrates and proteins.

In general, children following a ketogenic diet must avoid:

Starches

Grains

Sugars

Most fruits and vegetables

All meals and snacks must be weighed on a scale, and recipes are planned in advance.

To start the ketogenic diet, your child will stay in the hospital so the nutrition team can care for them while they adjust to their new diet. Once on the diet, your child will have routine follow-up appointments to make sure they are doing well. Many children are on the diet for 2 years or more.

Modified Atkins diet

The modified Atkins diet (MAD) includes eating foods that are high in fat and very low in carbohydrates.

Unlike the ketogenic diet, children do not need to stay in the hospital to start the diet. It does not require that food be measured with a scale.

Laser ablation (LAY-zhur a-BLAY-shun) uses light to heat and destroy unwanted cells, including lesions that can cause epilepsy. It may be a good choice, and even a cure, for children who have few or no other treatment options. It is especially useful if lesions are deep in the brain and hard to reach with traditional surgery. We are among the few children’s hospitals in the country that offer laser ablation for epilepsy. Read more about laser ablation.

For some children, treatment options include minimally invasive procedures using an advanced surgical tool called ROSA Brain. It integrates brain imaging with a robotic arm. Our neurosurgeons use ROSA to target areas of your child’s brain with more precision and avoid removing part of their skull (craniotomy). This shortens the time your child is in surgery and under anesthesia. Read more about ROSA Brain.

This testing checks your child’s brain development and how the brain is linked to their behavior. We do many tests to check your child’s memory, attention, thinking, language skills, coordination, senses and personality. Read more about neuropsychological testing (PDF).

A battery-powered device is placed in your child’s skull to reduce seizures. The neurosurgeon connects thin wires (leads) from the device to 1 or 2 parts of the brain where your child’s seizures start. When the device senses that a seizure may be starting, it sends a signal to stop it. Our patients who are 18 years and older have access to this new treatment because we are part of the UW Regional Epilepsy Center.

This is an alternative to brain surgery. The vagus (VAY-gus) nerve stimulator helps prevent seizures by sending a weak, on-and-off electrical current. Surgeons implant the stimulator in your child’s chest and connect it by wires to the vagus nerve. The vagus nerve starts in the brainstem and goes down the neck and into the chest.

We have a special area in our hospital devoted to monitoring children’s brain activity (Epilepsy Monitoring Unit). We use video and EEG equipment to look for clues to your child’s seizures. An EEG is a painless recording of the brain’s electrical activity. Monitoring helps us diagnose your child and plan the best treatment. Learn more about inpatient EEG testing(PDF) (Spanish) (Russian) (Vietnamese).

Conditions We Treat

We see children with a broad range of neurological conditions that involve seizures, including:

In epileptic encephalopathies (en-seff-uh-LAW-path-ees), children have repeated seizures that cause severe problems in thinking and behavior over time. For example, children with Landau-Kleffner syndrome lose the ability to speak. They often have seizures while they are sleeping. Rasmussen’s syndrome causes a slow loss of function on 1 side of the brain. The affected side of the brain can cause seizures and weakness on the opposite side of the body. Often the cause of these conditions is genetic.

Malformations of cortical development are an important cause of epilepsy in children. These malformations may involve the whole brain or small regions, which are called cortical dysplasias. These happen if tissue in part of the brain (cerebral cortex) does not develop properly before a baby is born. Patches of this abnormal brain tissue cause seizures and developmental delays. Cortical dysplasia is a common cause of intractable epilepsy that cannot be controlled with medicine. Your child’s doctor may recommend surgery.

Mitochondria in cells help make almost all of the energy people need to live and grow. In children with mitochondrial disorders, these energy-making areas do not work as they should. This damages cells and causes different kinds of symptoms, depending on which cells are damaged. Children with some kinds of mitochondrial disorders have repeated seizures. We have a specialized team to care for children with mitochondrial disorders.

This group of epilepsies used to be called idiopathic generalized epilepsies. Idiopathic means the cause is unknown. Many people with these epilepsies have generalized tonic clonic seizures (previously called grand mal seizures). The seizures include a tonic phase – muscle stiffening, crying or groaning and passing out (loss of consciousness). This is followed by the clonic phase – arms and legs jerking quickly and rhythmically. These seizures generally last from 1 to 3 minutes. If they last longer, they usually need emergency treatment. Generalized tonic-clonic seizures are usually controlled with medicine.

Infantile spasms are a type of seizure. They happen during infancy and childhood and are part of an epilepsy syndrome called West syndrome. The spasms often come in clusters of 100 or more. Children with infantile spasms may have several hundred spasms a day.

Children and teens with intractable (in-TRAK-tuh-bull) epilepsy have seizures that cannot be controlled by medicines alone. If 2 appropriate medicines are tried for a sufficient length of time and don’t control the seizures, the epilepsy is called intractable. This happens to 1 in 3 people with epilepsy. This can severely affect a child’s physical, social and emotional development. Surgery is often a treatment option.

Children with juvenile myoclonic (my-uh-KLAHN-ik) epilepsy have mild seizures with quick jerks of the arms, shoulders or sometimes the legs. These sometimes are followed by a tonic-clonic seizure. Children may also seem to blank out for a few seconds to several minutes. Most JME seizures can be controlled with medicine. This is 1 of the more common genetic generalized epilepsy syndromes.

An abnormal gene causes pyridoxine-dependent epilepsy. Children with this type of epilepsy have seizures that last several minutes. They are often treated with large doses of pyridoxine (peer-ih-DAHK-seen), a kind of vitamin B6.

These epilepsies are called self-limited because the risk for having seizures happens over a limited time in a person’s life. There are several self-limited focal epilepsy syndromes, which usually begin in childhood. The most common is self-limited epilepsy with centrotemporal spikes. It affects 15% of children with epilepsy and is the most common cause of seizures in school-aged children. Children with this type of epilepsy have seizures that cause twitching, numbness or tingling in their face or tongue. The seizures usually last 2 minutes or less. They may cause drooling and problems with speech. They also can spread and become generalized seizures. Many children do not take medicines for the condition because they have few seizures, usually at night. It used to be called benign rolandic epilepsy (BRE).

Tuberous sclerosis (sklih-RO-sis) complex (TSC) is a rare genetic disease that causes tumors to grow in various parts of the body, including the brain and other vital organs. The tumors are benign (noncancerous). They affect a child’s development in different ways, depending on where they grow and how big they get. Over 80% of patients with TSC develop epilepsy. Learn more.

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